Healthier Patients May Have To Wait For Costly Hepatitis C Drugs

Expensive new drugs for hepatitis C may work better than older treatments, but their high cost undermines their value, a panel of experts said Monday during a daylong forum in San Francisco.

"The price makes it very hard for the health care system," said Steve Pearson, who oversaw the meeting for the California Technology Assessment Forum, a group affiliated with health insurers that holds public meetings to weigh evidence on new treatments.

The 15-member panel, which included representatives of hospitals, insurers and patient advocates, didn't recommend how use of the drugs should be prioritized. Sovaldi, which hit the market late last year, is made by Gilead Sciences and costs $1,000 a pill. Slightly less expensive is Olysio, made by Johnson & Johnson. A course of treatment with the drugs can cost $66,000 to $84,000, or more.

The panelists and experts who testified nearly all agreed that because of the cost and for medical reasons, not every patient with hepatitis C needs to be immediately treated with the new drugs. It is estimated there are at least 3 million Americans with the viral infection.

"I can't imagine how that would be feasible without bankrupting our system," said Rena K. Fox, a professor of medicine at the University of California, San Francisco. "What I really wish for is that we could push back on the price, rather than make patients wait. But since we don't have the ability to change the price, we have to decide which patients are the most urgent."

The drugmakers defend the prices, citing research costs and evidence that shows the pills cure many patients.

Waiting might be a better answer for some patients — particularly those with little or no liver damage — because other treatments are expected to hit the market within a year, outside experts and some panel members said. Patients with more advanced liver damage from the virus would be treated first.

Healthier people had also waited to use the older drugs, hoping for something to come along that would have fewer side effects.

Hepatitis C is a chronic liver infection that can take years or decades to progress. Over time, it can lead to cancer, cirrhosis or the need for a liver transplant.

At least 70 percent of those infected have no symptoms. The virus is spread mainly by intravenous drug use, but many people were unknowingly infected by poorly sterilized medical equipment and blood transfusions before widespread screening of the blood supply began in 1992. Some may also have been infected through tattoos and piercings with contaminated needles.

Patients may not want to wait, said Ryan Clary, executive director of the National Viral Hepatitis Roundtable, a consumer group partially funded by the drug industry. Television advertisements sponsored by Gilead are encouraging people to be screened for hepatitis and to talk with their doctors about new treatment options. The Centers for Disease Control and Prevention recommends that all baby boomers be tested for hepatitis C.

"If I was hepatitis C-positive and someone said there's this great treatment, but can you hold off because you're healthy and it might bankrupt the system ... patients don't think like that," said Clary, who spoke at the forum.

Private insurers, as well as those serving Medicaid patients, are wrestling with how to cover the new drugs. Many say they will require prior approval and may be limited to the sickest patients. Some Medicaid insurers have asked states for additional help in paying for the drugs.

A draft report prepared in advance of the San Francisco forum estimates that if every patient in California with advanced liver damage were treated, the cost would be $6.3 billion.

The panel's recommendations — including votes on questions about the effectiveness of the new treatments compared with older regimens — will be released within a month.